Dr Allan Cyna
Women’s and Children’s Hospital, Adelaide South Australia
Anaesthetists are key members of burns team patient care. Their role may involve anaesthesia care for multiple procedures including for grafting and scar management, initial resuscitation, intensive care and the provision of analgesia for dressing changes. Effective communication with patients and their families as well as other members of the burns care team is vital. There is however little guidance, addressing how team members might optimise their communication during burns care pre-, intra-, and postoperatively. Advances in the understanding of the neurobiology of communication suggests that we need to consider positive (placebo) or negative (nocebo) subconscious processes. Learnable language structures GREAT (Greeting, Rapport, Expectations, Addressing concerns, Tacit agreement) and LAURS (Listening, Acceptance, Utilisation, Reframing, Suggestion)1 can facilitate any patient or family interaction ensuring burns patients feel they are being heard and understood. Talking about ‘finishing’ rather than ‘starting’ when about to perform a potentially painful procedure focusing on maximising safety and comfort and can be a powerful therapeutic adjunct in patient care. For example, rather than enter the patient’s room and warn them of an impending dressing change on the ward and letting them know this will start soon followed by an apology for any pain they might have once it starts. An alternative approach is to have everything prepared before-hand and then ask the patient if it’s OK to ‘finish placing some cool and comfortable, clean dressings so that the skin can heal and recover more quickly and allow you to leave hospital sooner?’ Other strategies include the avoidance of nocebo communications before or during a potentially painful procedure and, instead, focusing on therapeutic (placebo) alternatives.2 Stressed patients and children with burns do not view pain in the same way as they do when they are not stressed. Techniques such as ‘Lived in imagination’, guided imagery and hypnotic communication can be valuable adjuncts to pharmacological analgesia techniques in burns care, with the added benefit of minimising side-effects and empowering patients. The use of regular ‘time-outs’ during prolonged burns surgeries is a helpful communication strategy between the anaesthetist and other members of the burns team that can optimise patient safety.3
References
1. Cyna AM, Andrew MI, Tan SG. Communication skills for the anaesthetist. Anaesthesia. 2009 Jun;64(6):658-65. doi: 10.1111/j.1365-2044.2009.05887.x. PMID: 19453320.
2. Arrow KA, Burgoyne LL and Cyna AM. Implications of Nocebo in Anaesthesia Care: Anaesthesia and the Brain. Anaesthesia January 2022; (In press).
3. Cyna AM. Little words BIG impact: Perioperative communication for children with burns. Anaesth Intensive Care. 2020 Mar;48(2):123-128. doi: 10.1177/0310057X20914909.
Biography:
Dr Allan Cyna is a Senior Consultant Anaesthetist at the Women’s and Children’s Hospital and Clinical Associate Professor at the University of Adelaide. He is Chair of the Communication in Anaesthesia SIG (ANZCA, ASA, NZSA), Course Director of the South Australian Society of Hypnosis training course and a past President of the Australian Society of Hypnosis. Following his PhD on the effects of hypnosis on pain, he has developed a special interest in using hypnotic communication as an adjunct to anaesthesia care and pain management – particularly with children suffering burns. Dr Cyna has published widely including as Editor in Chief of the Handbook of Communication in Anaesthesia & Critical Care.